
Ankylosing Spondylitis
A complete guide for patients...
Ankylosing spondylitis (AS) is a type of arthritis that mainly affects the back. It causes inflammation in the joints of the spine, leading to pain and stiffness. The word ankylosing means joining together or fusing and spondylitis means inflammation of the spine. The type of inflammation in AS causes the affected joints to join together and become one bone.
What causes Ankylosing spondylitis?
The exact cause is not known. However, there is a strong hereditary (genetic) tendency associated with a gene called HLA-B27. This can be requested by your doctor as a blood test if your symptoms are suggestive of AS, however it is important to remember that patients without the gene can also have AS. It can be triggered following a gut/ genital infection.
Symptoms of Ankylosing Spondylitis ?
Lower back or neck pain and stiffness in the morning which wears off during the day or with activity. The stiffness that lasts at least 30 minutes in the morning helps to distinguish AS from simple back pain. It may also occur after rest, or it may wake you in the night. The stiffness can be eased by exercise or movement. Pain in your sacroiliac joints (the joints where the base of your spine meets your pelvis), your buttocks or the backs of your thighs.
Other possible symptoms are:
- Pain and swelling in joints other than those in the spine
- Tenderness or discomfort around your heels
- Swollen fingers or toes
- Eye inflammation (painful, bloodshot eyes).
The pain due to disc problems or any degenerative spine condition is worsened on movement.
How is Ankylosing Spondylitis diagnosed?
You will be have blood tests like inflammatory markers and antibody tests to exclude other forms of arthritis.
HLA B27 is the genetic test which is usually positive in patients with AS, however this test can be negative in 4-5 % of patients.
A MRI scan of lumbar spine and sacroiliac joints will be requested to help confirm the diagnosis as it can show inflammation which is active and distinguish from other causes like disc problems (PID) and infection like tuberculosis and brucellosis. A xray also helps if the arthritis has been there for some time.
Why is it important to treat patients with Ankylosing spondylitis?
Once the diagnosis is made important to keep regular follow up with Rheumatologists to assesses disease severity and suggest treatment accordingly.
Most patients can have pain relief with initial treatment but should be assessed regularly to ensure no future joint damage occurs. If left untreated irreversible fusion of spine with new born formation occurs which is usually preventable.
What is the treatment of Ankylosing Spondylitis?
The aims of treatment are to ease pain, stiffness and to keep your spine as mobile and flexible as possible. It is important to diagnose and treat this condition early to slow down the progress of the disease.
Pain killers or anti-inflammatory - This is the first line of treatment which in most patients & offers excellent response in 48-72 hours of use. There is reduction in pain, stiffness in most patients.
When few patients have severe disease and are not responsive or become dependent on anti-inflammatory treatment anti - TNF (tumor necrosis factor) treatment is indicated. They have excellent outcomes with halting of disease process.
Can Ankylosing Spondylitis affect females?
Yes , AS can affect females.
Ankylosing spondylitis can affect anyone, although it’s more likely to start in your late teens and between 20- 40 years of age. It is three times more common in men than in women.
Role of Exercise
Bed rest isn’t recommended as this can speed up the stiffening of your spine. Exercises for your back, chest and limbs will keep them supple. Be careful not to overdo it, but try to do at least some exercise each day. Stretching exercises after a hot bath or shower are especially good for easing morning stiffness.
Swimming is one of the best forms of exercise because it uses all of your muscles and joints without jarring them.
Role of Surgery
In patients who have developed chronic damage and restricted mobility of the spine, hip and neck may require surgery.
What other symptoms can Ankylosing Spondylitis patients have?
- Tenderness at the heel called enthesitis – This makes it uncomfortable to stand on a hard floor. Inflammation can occur at the back of your heel where the Achilles tendon meets the heel bone, or in the tendon in the arch of the foot which is known as plantar fasciitis.
- Pain and swelling in a finger or toe – When the whole digit is swollen it’s known as dactylitis.
- Tenderness at the base of your pelvis – This makes sitting uncomfortable.
- Chest pain due to costochondritis or a ‘strapped-in’ feeling that comes on gradually – If your spine is affected at chest level ,it can affect movement at the joints between the ribs and the breastbone, which makes it difficult for you to take a deep breath. Your ribs may be very tender, and you may feel short of breath after even gentle activity. Coughing or sneezing may cause discomfort or pain.
- Inflammation of the eye (uveitis or iritis) – The first signs of this are usually a red (bloodshot), watery and painful eye, and it may become uncomfortable to look at bright lights. Treatment is usually with steroid eye drops, which are generally very effective. Some people get repeated attacks of eye inflammation, but they’re extremely unlikely to cause permanent damage if they’re treated promptly.
- Tiredness (fatigue) – This may be caused by the activity of the condition, anaemia or sometimes depression and frustration associated with the condition.
- Inflammation of the bowel – People with ankylosing spondylitis can develop bowel problems known as inflammatory bowel disease (IBD) or colitis. Tell your doctor if you have diarrhoea for more than 2 weeks or begin to pass bloody or slimy stools. You might be referred to a bowel specialist (gastroenterologist). Symptoms of IBD can vary, but it can usually be treated successfully with medication. Sometimes treatments like non-steroidal anti-inflammatory drugs (NSAIDs) can make bowel problems worse like bleeding, so you might be advised to stop taking them.